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Psychological stages in adaptation following burn injury: a method for facilitating psychological recovery of burn victims.

As a result of clinical observation of 444 patients hospitalized for treatment of acute burn injury at Humana Burn Center between July 1983 and October 1986, we have developed a seven-stage method of assessing and assisting the burn victim's psychological recovery. This method delineates the stages in the normal psychological healing process in burn victims and offers specific suggestions for staff interventions to assist the patient at each stage. This method can be utilized in an integrated fashion by all members of the multi-disciplinary burn team to expedite the patient's psychological recovery and to maximize his compliance with necessary treatment modalities.

Adaptation, Psychological↗
PubMed2002

Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked.

OBJECTIVE: Within the context of a large, nationwide outcomes research program in type 2 diabetes, we assess the prevalence of self-reported erectile dysfunction and evaluate its impact on quality of life. RESEARCH DESIGN AND METHODS: The study involved 1,460 patients enrolled by 114 diabetes outpatient clinics and 112 general practitioners. Patients were asked to complete a questionnaire investigating their ability to achieve and maintain an erection. Various aspects of quality of life were also assessed depressive using the following instruments: SF-36 Health Survey, diabetes health distress, psychological adaptation to diabetes, depressive symptoms (CES-D scale), and quality of sexual life. RESULTS: Overall, 34% of the patients reported frequent erectile problems, 24% reported occasional problems, and 42% reported no erectile problems. After adjusting for patient characteristics, erectile dysfunction was associated with higher levels of diabetes-specific health distress and worse psychological adaptation to diabetes, which were, in turn, related to worse metabolic control. Erectile problems were also associated with a dramatic increase in the prevalence of severe depressive symptoms, lower scores in the mental components of the SF-36, and a less satisfactory sexual life. A total of 63% of the patients reported that their physicians had never investigated their sexual problems. CONCLUSIONS: Erectile dysfunction is extremely common among type 2 diabetic patients and is associated with poorer quality of life, as measured with generic and diabetes-specific instruments. Despite their relevance, sexual problems are seldom investigated by general practitioners and specialists.

Aged↗
PubMed2004

[Analysis of medical/surgical complications of cutaneous ileostomy].

OBJECTIVE: Our objective is to carried out a descriptive study about medical-surgical complications and alterations about quality of life in stoma patients secondary to bladder tumour. PATIENTS AND METHOD: The series are composed of 67 patients. The mean age was 70.3 years. We analyse the following variable: early and late medical-surgical complications, the body mass index (BMI) change and the alteration of quality of life. RESULTS: The most frequent early complication is the ischemic necrosis (7%) without posterior repercussion. The late complications in frequency order are: peristomal dermatitis (18%), plane stoma (12%), peristomal hernia (12%), stenosis (9%) and granuloma (6%). The BMI changes don't conditionate a increase in the complications. The psychological adaptation is good in 92%, although the majority affirm a little changes in life-style, but they don't have a repercussion on quality of life. CONCLUSIONS: In this series we estimate a low incidence of complications. The preoperative counsel and the posterior following by the stoma care nurse-surgeon team, play a fundamental role on psychological adaptation after surgery.

Aged↗
PubMed2006

Predicting negative mood state and personal growth in African American and White long-term breast cancer survivors.

BACKGROUND: Relatively little research has examined cognitive processes that may impact psychological adaptation in older long-term breast cancer survivors (BCS). PURPOSE: This study investigated the strength of a conceptual model based on the literature and Uncertainty in Illness Theories which proposes that negative mood state and personal growth in older long-term White and African American BCS would be predicted by the combined influences of demographic and disease variables, social support, religious participation, and cognitive processes (uncertainty, catastrophizing, troublesome thoughts, and cognitive reframing). METHODS: Baseline data were gathered from 524 BCS (369 Whites and 155 African Americans, 5-9 years postdiagnosis) prior to their participating in an uncertainty management intervention program. The conceptual model was tested using structural equation modeling. RESULTS: The multigroup model showed good fit to the data and explained substantial variance in negative mood state and personal growth. Cognitive processes showed both direct and indirect effects on outcomes in the expected directions. Several ethnic differences were found: African Americans were more negatively affected by comorbidities and Whites by symptom distress, whereas cognitive reframing was a stronger predictor of personal growth for African Americans than Whites. CONCLUSIONS: This is one of the first studies to explore predictors of both negative mood and personal growth in a multiethnic sample of BCS. These findings suggest that cognitive processes play an important role in psychological adaptation to breast cancer survivorship. These processes are amenable to change, suggesting a logical target for intervention with this population.

Black or African American↗
PubMed1989

Pierre Janet and the breakdown of adaptation in psychological trauma.

In this reappraisal of the work of Pierre Janet at the centenary of the publication of L'automatisme psychologique, the authors review his investigations into the mental processes that transform traumatic experiences into psychopathology. Janet was the first to systematically study dissociation as the crucial psychological process with which the organism reacts to overwhelming experiences and show that traumatic memories may be expressed as sensory perceptions, affect states, and behavioral reenactments. Janet provided a broad framework that unifies into a larger perspective the various approaches to psychological functioning which have developed along independent lines in this century. Today his integrated approach may help clarify the interrelationships among such diverse topics as memory processes, state-dependent learning, dissociative reactions, and posttraumatic psychopathology.

Combat Disorders↗
PubMed1992

Typologies of family reaction to pediatric malignancies.

The psychologic adaptation of children with malignancies is influenced by the strategies that both the relatives and the other members of the family employ as a reaction towards the disease and the therapeutic progress. Our experience in the Department of Hematology of the University "La Sapienza": by carefully observing the communication styles, the distribution of roles, and the modification of the family organization up to the eventual adaptation to the disease, we have been able to identify various reaction typologies of the family, and also to evaluate their frequency and their varying functionality with time. A thorough analysis of these modalities of reaction may allow prompt recognition of problems related with psychologic and social adaptation of both the pediatric patient and his family, and may allow the adoption of pertinent strategies of intervention, in order to guarantee a better compliance throughout the whole therapy.

Adaptation, Psychological↗
PubMed1994

A cohort study of unemployment as a cause of psychological disturbance in Australian youth.

Data from the Australian Longitudinal Survey, conducted by the Commonwealth Department of Employment, Education and Training, were analysed to estimate relative risk of psychological disturbance accompanying unemployment in young people aged 15-24 years. Two cohorts were surveyed annually over 4 years during the mid-to-late-1980s; one from the general 15-24 year-old population (N = 8995), and the other selected from Commonwealth Employment Service records (N = 2403). Such large respondent numbers allowed control of confounding by exclusion to isolate employment transition groups suitable for hypothesis testing and quantification of causal relationships. Psychological morbidity was measured using binary outcomes of the 12 item psychological component of the General Health Questionnaire. Excluded from the analysis were those who: suffered from pre-existing physical health problems; were dissatisfied in their job; were self-employed; underwent marriage breakdown during the inter-survey period; had become widowed during the inter-survey period. A Bayesian probabilistic approach was used to calculate probabilities of psychologically normal respondents becoming psychologically morbid, given prior transition from employment to unemployment. Mantel-Haenszel analysis was utilised to estimate relative risks in comparison to a control group of those remaining employed, after controlling for age and gender. An overall relative risk of becoming psychologically disturbed as a consequence of becoming unemployed was estimated to be 1.51 (95% CI: 1.15-1.99). The overall relative risk of recovery from psychological disturbance upon re-employment in those with psychological disturbance was estimated to be 1.63 (95% CI: 1.08-2.48). Residual psychological effects of past unemployment experience and the effects of long-term unemployment were investigated, but found to be non-significant in this study. There was some evidence of psychological adaptation to unemployment, but this was statistically insignificant. Unemployment was a significant cause of psychological disturbance in young people who were initially employed, not suffering physical ill-health, and psychologically normal; conversely, re-employment reversed the effect.

Adaptation, Psychological↗
PubMed2000

The relationship of parental attachment and psychological separation to the psychological functioning of young adults.

The authors explored the interrelations between attachment patterns and psychological separation from parents as well as the contribution of these variables to adaptive psychological functioning. Among 153 university students in Greece, there was a positive association between security of attachment and freedom from guilt, anxiety, and resentment toward one's parents (conflictual independence); in contrast, there was an inverse relation between security of attachment and independence from parents in relation to emotional, functional, and attitudinal independence. Compared with the insecurely attached students, the securely attached students also scored higher on measures of self-esteem and lower on measures of anxiety and loneliness.

Adaptation, Psychological↗
PubMed1991

Adverse psychologic consequences of positive cytologic cervical screening.

Cervical cancer is still widely prevalent in the female population. This study explores the relationship of cervical cancer screening, positive versus negative Papanicolaou's test results, and psychologic status among lower-income minority women. All patients were interviewed 3 months after they had received initial test results. One hundred six women with normal Papanicolaou's test results were compared with 118 women who were referred for colposcopic examination for follow-up of positive test results. Women with positive Papanicolaou's-test results showed statistically significant elevations in worries about cancer and impairments in mood, daily activities, sexual interest, and sleep patterns. More fine-grained analyses revealed that the effects of positive results were most pronounced among those women who did not comply with colposcopy (n = 53). These findings suggest that lack of compliance with follow-up may maintain high levels of uncertainty about disease and may interfere with successful psychologic adaptation. Health education targeted to psychologically vulnerable individuals may reduce psychologic distress and enhance compliance.

Adolescent↗
PubMed2002

The pattern of the becoming-self in death and dying.

As part of a triangulated study that examined psychological adaptation in home hospice patients, the grounded theory method was used to generate social-psychological processes of dying. The pattern of the becoming-self was one of seven patterns that emerged. The responses and reactions of 15 dying persons described a pattern that was shaped by self-integration, inner cognition, creation of personal meanings, and connection to others and a higher being. The becoming-self supported humanism and veritivity as defined in adaptation nursing theory.

Adaptation, Psychological↗
PubMed1990

Differential effects of avoidant and attentional coping strategies on adaptation to chronic and recent-onset pain.

Examined the effectiveness of attentional and avoidant coping strategies for somatic, behavioral, and psychological adaptation to clinical pain. Subjects were 30 chronic and 30 recent-onset pain patients who used either attentional or avoidant coping strategies in response to their pain. Based on a review of the coping literature, it was hypothesized that subjects with recent-onset pain would demonstrate greater adaptation (lower anxiety, depression, lower pain severity and somatization ratings, and higher levels of social activity) when employing avoidant rather than attentional strategies. Chronic pain subjects using attentional strategies were predicted to demonstrate greater adaptation than chronic pain subjects using avoidant strategies. The results supported this "time x strategy" hypothesis. Implications for pain treatment programs are discussed, and suggestions are made for matching pain duration with patient coping style.

Adaptation, Psychological↗
PubMed2005

Positive affectivity and lifestyle in adulthood: do you do what you feel?

There is much evidence for the adaptive value of positive affect. Empirical work examining different facets of positive affect and their consequences for psychological adaptation remains sparse, however. This study (young, middle-aged, and older adults; N = 293) investigated the links between two dimensions of positive affect (positive involvement and pleasant affect) and two lifestyles (hedonic and growth related), each indicated by general value orientations, self-reported everyday activities, and activity aspirations. Structural equation models showed that pleasant affect and positive involvement constitute distinct dimensions evincing different age trends and relating differentially to hedonic and growth-related lifestyles. Specifically, pleasant affect, but not positive involvement, was related to a hedonic lifestyle, whereas positive involvement, and not pleasant affect, was associated with a growth-related lifestyle. These findings underline the importance of considering two dimensions of positive affect--pleasant feelings and positive involvement--separately when studying the link between affect and lifestyle.

Adaptation, Psychological↗
PubMed2002

Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors.

Research has indicated a weak relationship between the degree of physical problems and quality of life in patients with chronic obstructive pulmonary disease (COPD). The importance of adaptive psychological functioning to maintain optimum quality of life has long been recognized, but there is a lack of empirical evidence concerning the nature of psychological factors involved in adjustment to COPD. Ninety-two males completed questionnaires to determine their coping strategies, levels of self-efficacy of symptom management and social support. Adjustment was measured in terms of depression, anxiety and quality of life. Symptom severity, socioeconomic status, duration of disease and age, which have been demonstrated to be of consequence in COPD, were used as control variables in hierarchical multiple regression analyses. Higher levels of catastrophic withdrawal coping strategies and lower levels of self-efficacy of symptom management were associated with higher levels of depression, anxiety and a reduced quality of life. Higher levels of positive social support were linked to lower levels of depression and anxiety, while higher levels of negative social support were linked to higher levels of depression and anxiety. To maximize quality of life in patients with chronic obstructive pulmonary disease, psychological factors need to be carefully assessed and addressed.

Adaptation, Psychological↗
PubMed1997

Aging and depression: vulnerability and stress across adulthood.

This paper reviews research on the relationship between age and depression in adulthood, with a focus on depression in late life. Age differences in prevalence rates of major depression and depressive symptomatology raise questions about presentation and measurement of depression across adulthood, and suggest a changing salience of risk factors for depression from young adulthood through old age as well as to cohort differences in risk for depression. Applying a developmental perspective on biological change, psychological adaptation, and stress processes throughout adulthood shows that risk for depression onset in young adults is typified more through psychological vulnerability and stress, as well as genetic factors, while risk for depression in older adults typified more through comorbid medical and neurological disorder. Implications for research and clinical practice are discussed. This review of the relationship of age to depression shows that the study of psychopathology and adult development can inform each other.

Adaptation, Psychological↗
PubMed1988

[Psychological implications of cancer. I. Psychological consequences of the disease].

The psychological consequences of cancer are most frequently reactive and do not constitute a major psychiatric illness. Anxiety and depression are the two main psychological disorders which occur frequently but with variable intensity according to the type of disease, its course, as well as the individual and social background of the patient. Physical factors such as digestive disorders, pain, mutilation and sterility can undermine the psychological adaptation. Cognitive impairment is generally due to neurological localizations of the disease or to metabolic abnormalities. The interrelationship between somatic and psychological factors must be carefully analyzed in order to recognize the determinants of suffering and abnormal coping or behavior.

Adaptation, Psychological↗